1. Field of Invention
The present invention relates to a device and methods for securing tissue of the human body, and more particularly relates to an endoscopic suturing device for endoscopically suturing tissue with minimally invasive techniques.
2. Discussion of Related Art
Endoscopic apposition devices can be used in the body of a patient without the need to make an external incision in the patient. The device is controlled outside the patient by endoscopic techniques. The device may comprise a sewing or stapling device for use in flexible endoscopy, although it is also applicable to devices for use in rigid endoscopy.
Endoscopic apposition devices have been found to be useful in the treatments of the digestive system, with the endoscope being transorally inserted through a patient's esophagus. For example, such devices have been found useful in treating gastroesophageal reflux disease (GERD) by placing stitches to form tissue plications at the junction of the esophagus and stomach. The minor anatomical change resulting from the plication formation appears to relieve the symptoms of GERD in some patients. It is also being proposed to employ such devices in treating obesity by placing stitches to segregate portions of a stomach or revise prior surgical procedures.
Endoscopic sewing devices of this general type are described in, for example, U.S. Pat. Nos. 5,080,663 and 5,792,153, which disclose a sewing device for passing a thread or suture through a tissue portion. The sewing device comprises a hollow needle movable between a first position in which it is out of the tissue portion and a second position in which it passes through the tissue portion, and a thread carrier adapted to be attached to the thread and being receivable within the hollow needle. The sewing device also comprises a body which defines a cavity within which the tissue portion can be held by suction. The hollow needle is mounted for movement in the body between the first and second positions.
The sewing devices include a single stitch sewing device and a multiple stitch sewing device. In the single stitch device, the thread carrier is transported by the needle through the tissue as the needle passes from its first position to its second position. When the needle returns to its first position, the thread carrier is maintained in the distal end of the sewing capsule. In the multiple stitch device, the same procedure occurs, but it is followed by a further step in which the hollow needle travels from its first position to its second position, picks up the thread carrier, and returns it to the first position. A second stitch may be formed during the next step. The whole sequence of steps is repeated as many times as may be required to form the desired number of stitches.
After placement of the sutures through the tissue, the suture can be secured tightly by knots or by a mechanical locking device. U.S. application Ser. No. 10/220,413 (“Suture Clips, Delivery Devices and Methods”, filed Mar. 13, 2003) and Ser. No. 10/275,534 (“Tissue Capturing and Suturing Device and Method”, filed Nov. 6, 2002), which are incorporated by reference herein in their entirety, disclose mechanical locking devices for securing a suture in an internal body location that are deliverable by an endoscope.
When using sewing devices, such as those identified above, the suture is typically handled separately from the sewing device during a suturing procedure. It would be desirable to provide an endoscopic tissue apposition device that includes a suture management arrangement that provides and manages a supply of suture for placing one or more stitches during a single intubation.